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Progressive Dyspnea and Hypoxemia With Diffuse Pulmonary Infiltrates in a Previously Healthy Woman
Anne S Mainardi1, Alexa J Siddon2, Anna S Bader3
1Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Respiratory, Critical Care, and Sleep Medicine, University of Tennessee/Erlanger Health System, Chattanooga, TN.
Chest
|December 7, 2020
Summary
This case study highlights a 50-year-old woman with persistent cough, dyspnea, and fatigue. She developed fevers, night sweats, a distinctive rash, and significant lymphocytosis, indicating a complex medical presentation.
Area of Science:
- Internal Medicine
- Pulmonology
- Hematology
Background:
- A 50-year-old female presented with a 3-month history of respiratory symptoms including cough and dyspnea.
- She also reported constitutional symptoms such as fevers and night sweats, alongside a new-onset rash.
Observation:
- The patient exhibited tachycardia, tachypnea, and hypoxia (oxygen saturation 81% on 2 L/min oxygen).
- Physical examination revealed cervical and axillary adenopathy, bibasilar pulmonary crackles, conjunctival edema, and an acneiform rash with nonblanching macules and papules.
Findings:
- Admission laboratory results were notable for a markedly elevated white blood cell count (56,000/µL) with a predominance of lymphocytes (79.5%).
- Hemoglobin and platelet counts were within normal limits.
Implications:
- This presentation suggests a potential lymphoproliferative disorder or an atypical infectious process requiring further investigation.
- The constellation of symptoms, physical findings, and laboratory results underscores the importance of a comprehensive diagnostic approach in complex cases.
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